Hand Surgery in New Jersey

ands are one of the primary ways people interact with the world. They are essential for many everyday activities, from eating and getting dressed to playing sports or creating art. Conditions that affect the hands are not only painful, but they also have a debilitating impact on day-to-day life. Individuals with hand conditions may struggle to complete normal tasks or enjoy favorite pastimes.

Centers for Neurosurgery, Spine & Orthopedics (CNSO) features a comprehensive team of specialists in northern New Jersey, including a hand surgeon. CNSO uses cutting-edge techniques to help patients with hand conditions find lasting relief, including pain management and hand surgery treatments.

Conditions Treated With Hand Surgery

CNSO employs a conservative treatment philosophy. Before recommending invasive procedures like hand surgery, the care team always considers whether non-invasive pain management or physical therapy will be effective. In some cases, however, surgery is necessary.

The hand surgeon at CNSO, Dr. Hakan Kutlu, is proficient in treating a wide variety of conditions that affect the fingers, hand, wrist, and forearm. Conditions CNSO treats with surgery include:

Osteoarthritis: This degenerative condition is caused by wear and tear that breaks down joint cartilage. This creates friction in the joint, resulting in pain, swelling, and loss of mobility.
Rheumatoid arthritis: This is a chronic inflammatory disease that occurs when the immune system attacks the joint linings, causing painful swelling that breaks down cartilage and bone.
Carpal tunnel syndrome: This overuse injury results from inflamed tendons in the wrist. This compresses the median nerve, causing pain, tingling, and numbness in the hand.
Cubital tunnel syndrome: This overuse injury results from an inflamed tendon in the elbow. It creates nerve compression, causing pain, tingling, and numbness in the forearm and hand.
Compartment syndrome: This condition is caused by a buildup of pressure around muscles in the hand. It may occur after an injury or may develop gradually due to repeated stress.
Dupuytren’s contracture: This occurs when connective tissue in the hand becomes abnormally tight. The tissue pulls fingers inward, making it difficult to use the hand for certain tasks.
Fractures: Because hands are so heavily used, bone fractures are common. Fractures may affect the small bones in the fingers (phalanges) or the long bones in the palm (metacarpals).
Infections: Hand infections are another common condition caused by injury. They occur when bacteria develop in a wound or spread to the hand from other areas of the body.
Nerve damage: Injury, carpal tunnel syndrome, and other conditions may cause permanent nerve damage, resulting in tingling sensations, numbness, or pain in the hand.
Ganglion cyst: Ganglion cysts are fluid-filled lumps that develop along the tendons or joints in the wrist or hand. They are often painful and can inhibit normal movement.
Trigger finger: This overuse condition results when a finger tendon cannot glide smoothly through its sheath, causing the finger to become stuck in a bent position.

Hand Arthrodesis

Arthrodesis, also called joint fusion, is a procedure commonly used to treat osteoarthritis, rheumatoid arthritis, and some severe fractures. The process uses metal plates and screws to fuse bones together across the joint. Over time, the bones grow together into a single unit. This strengthens and stabilizes them while fully eliminating pain in the affected joint.

This procedure provides complete pain relief at the expense of mobility. Joints treated this way will have little flexibility afterward. Because of this, hand arthrodesis is recommended only when the patient has already lost significant mobility or when other treatments have failed to provide relief.

Carpal Tunnel Release

Carpal tunnel release is a surgical treatment for severe carpal tunnel syndrome. During the procedure, the surgeon severs the carpal tendon to widen the carpal tunnel. This relieves pressure on the median nerve, reducing or eliminating symptoms of nerve compression. Pain typically disappears quickly, though some symptoms may take weeks or months to go away completely.

Release procedures are effective in treating most cases of carpal tunnel syndrome. Relief is long-lasting, and further surgeries are typically not required to maintain good results. In some cases, however, very severe carpal tunnel syndrome may have caused permanent nerve damage. For these patients, surgery will only relieve some of the symptoms. Additional procedures may be necessary to repair the damage.

Ulnar Nerve Release

An ulnar nerve release procedure is used to treat cubital tunnel syndrome. This procedure involves opening the fascia in the elbow. The fascia is a sheath of strong tissue enclosing the tendons and nerves. By opening it, the surgeon creates extra room around the ulnar nerve. This reduces pressure to relieve uncomfortable symptoms.

In some cases, Dr. Kutlu may also move or “transpose” the nerve in front of the bone. This extra step helps to stabilize the nerve and ensure it stays in one location after the fascia has been cut. It may also provide additional relief for patients with severe nerve compression or those who have previously undergone ulnar nerve release surgery without improvement.

Like carpal tunnel release, ulnar nerve release is frequently effective in treating nerve compression. The positive results are long-lasting and do not require further procedures. It cannot, however, provide complete relief for nerves that are permanently damaged by compression. In these cases, a second surgery may be necessary to repair the damaged nerve.

Fasciotomy Surgery

Fasciotomy is performed to treat compartment syndrome and may also help mild cases of Dupuytren’s contracture. Dr. Kutlu makes an incision in the hand or arm, which creates an opening in the skin and fascia. This decreases pressure around the muscle tissue and restores normal blood flow. Damaged tissue may also be removed if necessary. The incision will be closed once the pressure goes away. If the pressure does not recede, a skin graft may be used to cover the incision.

Compartment syndrome can cut off blood flow in the hand, causing permanent damage and tissue death. This is a condition usually associated with high velocity trauma or crushing conditions. Fasciotomy is an effective way to reduce pressures within the affected extremity to prevent this damage while the body heals. While it may not correct the damage that has already occurred, it will stop the condition from worsening and allow the patient to maintain function in their affected hand.

Fasciectomy Surgery

Fasciectomy is a surgical procedure used to treat Dupuytren’s contracture. During this procedure, the surgeon removes the fascia or connective tissue, freeing the hand to flex and extend normally. A few different versions may be used depending on the condition’s severity:

Segmental (partial) fasciectomy: The surgeon removes only the diseased fascia that is causing contracture, leaving healthy tissue behind.
Subtotal palmar fasciectomy: The surgeon removes all the fascia in the hand, including healthy tissue, to prevent the condition from spreading or recurring.
Dermofasciectomy: The surgeon removes the diseased fascia and part of the skin. A skin graft will be necessary to replace the removed tissue.

Fasciectomy is effective in restoring normal hand flexibility and function and has longer-lasting results than non-surgical treatments. Some numbness or tingling is normal immediately after the procedure. This is caused by contracted nerves stretching to fit the healthy hand shape and is a temporary problem that will improve as the hand heals.

Surgical Drainage and Debridement

Most early hand infections can be treated using warm soaks, rest, and antibiotics. Severe or deep-set infections, however, may require surgical treatment. During surgical drainage, the surgeon cuts into an infected sore or abscess. The area is explored to remove any non-viable tissues or foreign material and washed out with antibiotic solutions. The affected area may be left open to allow for further drainage and ongoing local wound care.

Severely infected wounds may also require debridement. This procedure involves cleaning and removing contaminated tissue from around the wound. This prevents the infection from spreading while giving new, healthy tissue room to grow for a smoother healing process.

Ganglion Cyst Removal

Ganglion cyst removal is used to treat cysts that have resisted conservative methods. During this procedure, the surgeon removes the entire cyst along with its capsule or stalk. The opening is then stitched closed to enable healing.

Removal of large ganglion cysts can provide immediate relief for patients whose condition is painful or movement-inhibiting. It eliminates pain and restores function to the hand, allowing the patient to return to normal activities. However, it does not eliminate the possibility of recurrence or developing cysts in adjacent areas.

Nerve Repair

Nerve repair is performed to restore function and sensation caused by permanent nerve damage due to an injury, carpal tunnel syndrome, or cubital tunnel syndrome. A few variations on the procedure may be used depending on the cause and severity of nerve damage:

Direct repair: If the nerve is cut sharply, the ends may be reconnected. Dr. Kutlu trims away damaged nerve tissue, then stitches the nerve ends together.
Nerve graft: If a large amount of nerve tissue is damaged, a graft may be used to bridge the gap. The graft tissue is taken from elsewhere in the patient’s body.
Nerve transfer: If reconnecting a damaged nerve is not viable, Dr. Kutlu may reroute a healthy, redundant donor nerve to the end of the damaged nerve.

All three procedures are employed in attempts to restore sensation and mobility to the affected hand. While full pre-injury sensation/function may not be restored, significant improvements can be achieved.

Trigger Finger Release

Trigger finger release is a surgery performed to restore function to a hand affected by trigger finger. Beforehand, the patient may undergo attempts at conservative treatment with localized steroid injections. If they do not respond to conservative therapy, surgery may be recommended involving the release of the “A1” pulley at the base of the finger, allowing the tendon to move freely.

This procedure immediately restores movement to the finger. Patients can move their finger right after surgery and are encouraged to exercise it often to rebuild strength and mobility. Most patients will find that their hand flexibility is completely restored. If there was severe loss of mobility before surgery due to joint issues, however, some stiffness may remain afterward.

Speak With a Hand Surgeon in New Jersey

Hands are important to a person’s everyday function. Individuals who struggle with a painful or movement-inhibiting condition can find relief through hand surgery at Centers for Neurosurgery, Spine & Orthopedics. CNSO’s all-inclusive care team is composed of neurosurgeons, orthopedic spine surgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists, working together to provide comprehensive care from diagnosis to recovery. Treatment is available at multiple convenient locations in northern New Jersey, including Bergen, Passaic, Essex, Morris, and Hudson counties. Contact CNSO today to schedule an appointment with a hand surgeon in northern New Jersey.

Frequently Asked Questions About Hand Surgery

Who performs hand surgery at CNSO?

The hand surgeon at CNSO is Dr. Hakan Kutlu. Dr. Kutlu is a leading, board-certified surgeon who is competent in treating a wide variety of conditions.

What conditions are treated with hand surgery?

CNSO uses hand surgery to treat a wide variety of conditions, including:

Osteoarthritis
Rheumatoid arthritis
Carpal tunnel syndrome
Cubital tunnel syndrome
Compartment syndrome
Dupuytren’s contracture
Fractures
Infections
Nerve damage
Ganglion cyst
Trigger finger

Will hand surgery treat all symptoms?

Surgery is effective in relieving or improving most symptoms of hand injuries or conditions. In some cases, lingering pain or stiffness may be experienced after surgery. However, the patient will often find that their condition is much improved. Results also depend on the patient’s underlying condition, medical issues, and compliance with recommended post-operative occupational therapy.